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>> The Challenge
>> Our Service
>> Our Approach
>> Benefits
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OUR SERVICE
RCS will gather, review and summarize core contract and performance information for each
payer and insurance product. The contract information will be prepared and presented in
a summary matrix format for your quick reference, and a separate, more comprehensive
summary will be prepared for each payer. RCS will update all pertinent contract information
quarterly to ensure all key departments are working with the latest information. RCS can
also provide expert consultation about contract modifications, bargaining strategies and other
contract issues. In fact, because of our exposure to a wide variety of contractual relationships,
many of our clients take advantage of our all-inclusive negotiation services.
Core contract information includes:
- Payer contact name, address, telephone and email
address
- Term of contract
- Rate methodologies by service w/ date of last revision
- Time limit to submit initial claim
- Time limit to make payment determination
- Time limit to appeal denied claim
- Network affiliates and other covered entities
Performance information includes:
- Average insurance payment percentage relative
to gross charge
- Average lag time from claim submission to receipt
of payment
- Average patient responsibility per paid claim
- Average volume and charge amount of claims denied
- Denial breakdown by category.
- Key considerations for improved performance and
profitability
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